Actinomadura meyerae osteitis following wound contamination with hay in a woman in France: a case report

We describe a case of Actinomadura meyerae osteitis in a 49-year-old Caucasian woman who suffered a tibia open fracture contaminated with hay; to the best of our knowledge the first case of autochthonous A. meyerae infection reported in France. The bacterium was cultivated from a bone biopsy. Following surgical osteosynthesis and six months of treatment with cotrimoxazole, our patient made a full recovery.Our case report suggests that A. meyerae is a potential agent of wound infection in farm workers in contact with hay.Infections caused by Actinomadura species, Gram-positive bacilli that belong to the family Thermomonosporaceae within the order Actinomycetales, are common in tropical and subtropical areas [1]. They are mostly caused by Actinomadura madurae and Actinomadura pelletieri. In Europe, only four cases of Actinomadura infections have been reported to date, caused by Actinomadura sp. [2,3], A. madurae [4] and Actinomadura sputi [5]. We report the first case of Actinomadura meyerae infection in a patient who developed osteitis following contamination of an open fracture wound with hay.A 49-year-old Caucasian woman working on a farm in Vichy, France, experienced an open fracture of the left tibia caused by a hook lifting a haystack. Subsequently, she was admitted to hospital. The fracture was reduced with a locking compression plate (Synthes, Oberdorf, Switzerland). Then, five days later, our patient developed a fever of 38.5°C, and oral treatment with amoxicillin-clavulanic acid, 6 g/day, was started; eight days after starting this treatment, the first antibiotic was replaced with oral ciprofloxacin (1.0 g/day) for three months. During that time, the cutaneous wound healed, but successive X-rays showed that bone healing was not obtained. Seven months following surgery, our patient broke her tibia locking compression plate while walking. Then, four weeks later, she was admitted to hospital. On examination, our patient had swelling and pain of the leg at the f